Hybrid Lit Annotated Bib

Medical Marijuana and Veterans: Truly a treatment for chronic pain and PTSD?
Hybrid Literature and Annotated Bibliography Review
Janae Debeltz
jdebeltz@knights.ucf.edu
IDS 4934- Interdisciplinary Studies Capstone Spring 2019
Devon Caldwell Bazata
College of Undergraduate Studies
University of Central Florida

Section I—Introduction and Problem Statement
Chronic pain and Post Traumatic Stress Disorder (PTSD) afflict many veterans and
military personnel world-wide, which provokes a multitude of problems with these individuals’
physical, mental, and emotional abilities; however, alternative treatment methods allow these
patients a different path than continuing opioid treatment while providing the possibility of
regaining most function within a short time frame. Unfortunately, the alternative treatment of
medical marijuana—that assists some veterans with PTSD and chronic pain—is fairly complex
in nature due to the legal situation involved, the depth of information required to
comprehensively understand the treatment itself, and the process of obtaining the prescription
itself. A singular discipline cannot analytically approach this treatment method alone because
singularly no discipline provides enough information to completely analyze the process involved
to obtain, the plant itself, and the pharmaceutical effects resulting from using marijuana. The
category of natural sciences provides information on the physical world while analyzing the
viewpoints involved with the disciplines and various factors within it. Medical marijuana utilizes
the disciplines of biology, chemistry, and earth science to understand the scientific basis of the
plant’s natural properties that allow humans to experience the pain-relieving and calming effects.
The social sciences provide two disciplines that assist with understanding the interdisciplinary
factors concerning medical marijuana. Political sciences provide a legal viewpoint towards
understanding federal and state laws that provide information towards continuing legal
processes. Since medical marijuana is currently a Schedule I controlled substance within the
United States and is considered federally illegal there are many laws associated with the plant
itself along with the process of producing and obtaining legal medical marijuana that may hinder
patients in obtaining their prescription. Economics allows for a concentrated understanding of
complex interactions between consumers and markets which provides data to be analyzed for
further clarification on subsections of economics. The medical marijuana market has quickly
become larger each month it is open within the United States and is becoming more widespread
by crossing new state lines each year. Since the marijuana market continues to grow, this
marijuana market provides a positive economic outcome for the states that approved this market.
The only humanities discipline involved with medical marijuana is history. Marijuana had been
used in medicine for centuries around the world before it was made illegal in the United States in
the early 20th century; today, this provides an obstacle for patients who want to use medical
marijuana for their chronic and debilitating conditions. Now, between 10% to 30% of returning
veterans have experienced PTSD and at least half of returning veterans experience some form of
chronic pain; as numbers continue to grow, veterans returning from overseas affected by these
debilitating conditions which require medications to control is becoming a larger issue in the
United States (U.S. Department of Veteran Affairs, 2018). A large portion of the time
medications prescribed to veterans are opioids and antidepressants, which can provide positive
and negative effects for them; however, some individuals do not wish to use these prescription
drugs due to the high-risk of abuse and addiction. In these cases, medical marijuana provides a
refuge for them as being one of the few holistic approaches to treat chronic pain and PTSD.
U. S. Department of Veterans Affairs. (n.d.). How Common is PTSD in Veterans? Retrieved
from https://www.ptsd.va.gov/understand/common/common_veterans.asp
Section II—Article Review and Annotated Bibliographies
Article 1: Bostwick, J. M. (2012). Blurred Boundaries: The Therapeutics and Politics of
Medical Marijuana, Retrieved from https://web-b-ebscohost-
com.ezproxy.net.ucf.edu/ehost/search/advanced?vid=28&sid=2e088d1b-0934-44a0-890d-
cb34817a16f2%40pdc-v-sessmgr03.
a) Abstract:
“For 5 millennia, Cannabis sativa has been used throughout the world medically, recreationally,
and spiritually. From the mid-19th century to the 1930s, American physicians prescribed it for a
plethora of indications, until the federal government started imposing restrictions on its use,
culminating in 1970 with the US Congress classifying it as a Schedule I substance, illegal, and
without medical value. Simultaneous with this prohibition, marijuana became the United States’
most widely used illicit recreational drug, a substance generally regarded as pleasurable and
relaxing without the addictive dangers of opioids or stimulants. Meanwhile, cannabis never lost
its cachet in alternative medicine circles, going mainstream in 1995 when California became the
first of 16 states to date to legalize its medical use, despite the federal ban. Little about cannabis
is straightforward. Its main active ingredient, -9-tetrahydrocannabinol, was not isolated until
1964, and not until the 1990s were the far-reaching modulatory activities of the endocannabinoid
system in the human body appreciated. This system’s elucidation raises the possibility of many
promising pharmaceutical applications, even as draconian federal restrictions that hamstring
research show no signs of softening. Recreational use continues unabated, despite growing
evidence of marijuana’s addictive potential, particularly in the young, and its propensity for
inducing and exacerbating psychotic illness in the susceptible. Public approval drives medical
marijuana legalization efforts without the scientific data normally required to justify a new
medication’s introduction. This article explores each of these controversies, with the intent of
educating physicians to decide for themselves whether marijuana is panacea, scourge, or both.”
b) Relation:
Blurred Boundaries focuses on a multitude of topics and essential issues within the marijuana
industry, both medically and recreationally. The article discusses: medical marijuana itself, the
dangers involved with use, dangers involved with early use, the relationship between marijuana
and psychosis, the complete endocannabinoid system within the human body, the pharmaceutical
applications, the federal barriers associated with marijuana, and the defiance shown by states
regarding marijuana. All but one of these sections are useful for my understanding and utilizing
of the information provided by the article regarding marijuana and our physiologic functioning
with it that could create a homeostasis. Due to the federal illegality of marijuana many federal
institutions are able to create potential bureaucratic hurdles for organizations and scientists to
research and evaluate the efficiency and effects that marijuana provides patients or recreational
users. Due to the high volume of information within the article, I will most likely utilize the
important facts within each section towards my research paper.
c) Key Insights:
Medical marijuana provides an oasis for many; however, there is still a plethora of information
we are unaware of regarding the alternative treatment. The endocannabinoid system information
within this article will provide another biological point within my research paper. The
reclassification of marijuana from a Schedule I controlled substance to a Schedule II controlled
substance is warranted in order to further research and understand the effects provided by
marijuana for patients as requested by the Institute of Medicine, the American Medical
Association, and the American College of Physicians (12).
“The first medical use probably occurred in Central Asia and later spread to China and India.
The Chinese emperor Shen-Nung is known to have prescribed it nearly 5 millennia ago,” (2).
“… randomized controlled trials of botanical cannabis in inexperienced users have not been
performed,” (4).
“… physiologic modulator not only of the central nervous system but also of the autonomic
nervous system, immune system, gastrointestinal tract, reproductive system, cardiovascular
system, and endocrine network,” (7).
“Of note, due to the near absence of brainstem CB1 receptors, the drug spares the autonomic
nervous system, no matter how much is ingested, with the result that a lethal overdose in hu-
mans has never been reported,” (8).
“Ben Amar11 writes that “for each pathology it remains to be determined what type of
cannabinoid and what route of administration are most suitable to maximize the beneficial effect
of each preparation and minimize the incidence of undesirable reactions,” (9).

“Without a federal umbrella, regulations lack any state-to-state uniformity about what constitutes
acceptable indications, appropriate prescriber-patient relationships, or legitimate means of
acquiring botanical cannabis,” (12).
d) Further Reading:
Turcotte D, Le Dorze JA, Esfahani F, Frost E, Gomori A, Namaka M. Examining the roles of
cannabinoids in pain and other therapeutic indications: a review. Expert Opin Pharmacother.
2010; 11(1):17-31.
Article 2: Davidson, E., Furmanov, K., Ginosar, Y., Haroutounian, S., Meidan, R., Ratz, Y., &
Saifi, F. (2016). The Effect of medicinal cannabis on pain and quality of life outcomes in chronic
pain: a prospective open label study. The Clinical Journal of Pain Publish Ahead of Print.
Retrieved from https://web-b-ebscohost-
a) Abstract:
“Objectives: The objective this prospective, open label study was to determine the long-term
effect of medicinal cannabis treatment on pain and functional outcomes in subjects with
treatment resistant chronic pain.
Methods:
The primary outcome was change in pain symptom score on the S-TOPS (Treatment Outcomes
in Pain Survey Short Form) questionnaire at 6 months follow up in intent to treat (ITT)
population. The secondary outcomes included change in S-TOPS physical, social and emotional
disability scales, pain severity and pain interference on brief pain inventory (BPI), sleep
problems, and change in opioid consumption.
Results:
274 subjects were approved for treatment; complete baseline data were available for 206 (ITT),
and complete follow-up data for 176 subjects. At follow up, pain symptom score improved from
median 83.3 (95% CI 79.2-87.5) to 75.0 (95% CI 70.8-79.2), P<0.001. Pain severity score (7.50
[95% CI 6.75-7.75] to 6.25 [95% CI 5.75-6.75] and pain interference score (8.14 [95% CI 7.28-
8.43] to 6.71 [95% CI 6.14-7.14]) improved (both P<0.001), together with most social and
emotional disability scores. Opioid consumption at follow-up decreased by 44% (P<0.001).
Serious adverse effects led to treatment discontinuation in two subjects.
Discussion:
The treatment of chronic pain with medicinal cannabis in this open-label, prospective cohort
resulted in improved pain and functional outcomes, and significant reduction in opioid use. The
results suggest long-term benefit of cannabis treatment in this group of patients, but the study's
non-controlled nature should be considered when extrapolating the results.”
b) Relation:
Unlike the other studies, this one was conducted in Jerusalem. In order to assess pain levels and
quality of life, the study required participants to respond a multitude of times to questionnaires
regarding: pain, treatment outcomes, and sleep problems. Most of the subjects showed
improvement in their conditions; however, some had to discontinue treatment due to adverse
effects that occurred during the treatment process. Due to there being two routes of
administration there is not enough data regarding which worked more effectively or which was
used most often; however, it can be determined that most of these chronic pain patients had a
beneficial experience from using marijuana for reducing pain and increasing their quality of life.
c) Key Insights:
Unfortunately, many of the patients considered for this study either were not able to participate
or had died previous to the study, so a total of 206 subjects were part of the intent to treat
population and 176 subjects were part of the per protocol population. After the study was
completed, the results indicated that pain symptoms improved in both testing group populations.
It is noted within the study that many of the study participants reduced their opioid therapy
resulting from this study. In general, it seems as if marijuana assisted chronic pain participants
with their quality of life and pain levels throughout the seven months this study was conducted.
“… pain symptom score was improved in 65.9% of subjects, did not change from baseline in
8.0%, and deteriorated in 26.1% of subjects,” (9).
“… PP analysis, the improvement in pain symptom score was similar – from 83.3 (95% CI, 79.2-
87.5) to 75.0 (95% CI, 70.8-79.2), P < 0.001,” (9).
“Of 73 subjects on opioid therapy at baseline, 32 have discontinued opioid treatment at follow-
up. This is a 44% reduction from baseline in the percentage of subjects receiving opioid
treatment…” (10).
d) Further Reading:
Whiting P. F., Wolff R. F., Deshpande S., Di Nisio M., Duffy S., Hernandez A. V., Keurentjes J.
C., Lang S., Misso K., Ryder S., Schmidlkofer S., Westwood M., & Kleijnen J. (2015).
Cannabinoids for Medical Use: A Systematic Review and Meta-analysis. JAMA : the journal of
the American Medical Association, 313: 2456-73.
Article 3: Bellnier, T., Brown, G. W., & Ortega, T. R. (2018). Preliminary evaluation of the
efficacy, safety, and costs associated with the treatment of chronic pain with medical cannabis.
Retrieved from https://web-b-ebscohost-
a) Abstract:
“Introduction: Medical cannabis (MC) is commonly claimed to be an effective treatment for
chronic or refractory pain. With interest in MC in the United States growing, as evidenced by the
29 states and 3 US districts that now have public MC programs, the need for clinical evidence
supporting this claim has never been greater.
Methods: This was a retrospective, mirror-image study that investigated MC's effectiveness in
patients suffering from chronic pain associated with qualifying conditions for MC in New York
State. The primary outcome was to compare European Quality of Life 5 Dimension
Questionnaire (EQ-5D) and Pain Quality Assessment Scale (PQAS) scores at baseline and 3
months post-therapy. The secondary outcomes included comparisons of monthly analgesic

prescription costs and opioid consumption pre- and post-therapy. Tolerability was assessed by
side effect incidence.
Results: This investigation included 29 subjects. Quality of life and pain improved, measured by
change in EQ-5D (Pre 36 – Post 64, P < .0001) and change in PQAS paroxysmal (Pre 6.76 – Post
2.04, P < .0001), surface (Pre 4.20 – Post 1.30, P < .0001), deep (Pre 5.87 – Post 2.03, P < .0001),
unpleasant (Pre “miserable” – Post “annoying”, P < .0001). Adverse effects were reported in 10%
of subjects.
Discussion: After 3 months treatment, MC improved quality of life, reduced pain and opioid use,
and lead to cost savings. Large randomized clinical trials are warranted to further evaluate the
role of MC in the treatment of chronic pain.”
b) Relation:
Within this study, only 29 patients were used to obtain data regarding chronic pain and medical
cannabis and 90% of that sample had non-cancerous chronic pain (Results; lines 5-6). The entire
sample was prescribed non-inhalable medical cannabis and was given an assessment prior to
treatment, after one month, and after three consecutive months. Also, the scholarly article
provides information regarding the compounds present within medical cannabis in order to assist
myself in biologically describing the analgesic effects provided by these compounds. Although a
small sample, the results indicate that medical cannabis is helpful with decreasing the amount of
opioid use.
c) Key Insights:
Unfortunately, this sample was only comprised of 29 people; this provides issues when
generalizing the data collected from the sample population. Additionally, this study had a lack of
blinding within the sample due to the patients being aware they were taking medical cannabis
along with selective bias due to not testing their sample for cannabinoids previous to beginning
the research. The study, although small, provides information regarding decreases with the
amount of opioids ingested, the pain experienced by patients, quality of life as reported, and
analgesic prescription costs.
“Paroxysmal pain decreased from 6.76 to 2.04 (P < .0001); surface from 4.20 to 1.30 (P < .0001);
deep from 5.87 to 2.03 (P < .0001); and unpleasant rating declined from “miserable” to
“annoying” after 3 months therapy,” (Results; lines 10-12).
d) Further Reading:
Hill, K. P. (2015). Medical marijuana for treatment of chronic pain and other medical and
psychiatric problems: a clinical review. JAMA. 313 (24):2474-83. DOI:
https://doi.org/10.1001/jama.2015.6199.
Article 4: Bohnert, K. M., Davis, A. K., Ilgen, M. A., & Lin, L.A. (2018). Recent cannabis use
among Veterans in the United States: Results from a national sample. Retrieved from
https://web-b-ebscohost-
a) Abstract:
“Background:
Compared to civilians, little is known about cannabis use among Veterans in the general United
States (US) population. This study aimed to examine the prevalence and correlates of recent
medical and non-medical cannabis use among this important US sub-population.
Method:
Data came from the 2014 National Survey on Drug Use and Health. Bivariate and multivariable
analyses were conducted that were weighted to account for the complex survey design.
Results:
Approximately 9% of Veterans in the US reported past year cannabis use. Older, and female,
Veterans had lower odds of past year cannabis use. Veterans who were unmarried, out of the
work force, had greater functioning disability, nicotine dependence, heavy episodic alcohol use,
alcohol use disorder, and drug use had greater odds of past year cannabis use. In states where
medical cannabis was legal in 2014, approximately 41% of Veterans who used cannabis in the
past year used medically. Those who used medically were older and less likely to engage in
recent heavy episodic drinking or to meet criteria for alcohol abuse/dependence, compared to
Veterans using non-medically.
Conclusion:
Compared to non-Veterans in the US general population, recent cannabis use was similar or
slightly lower among Veterans. However, among those with past year use, the proportion of
those using medically was more than double that of the general population. Because only non-
medical cannabis use was associated with higher rates of heavy episodic alcohol use and alcohol
use disorder, it may be important to address problematic alcohol consumption among this high-
risk group.”
b) Relation:
This scholarly article provides a prevalence study involving veterans, their recent cannabis use,
and the medical factors that allow legalization or criminalization of marijuana within their state.
The study analyzed the results obtained from their veteran sample through various categories:
medical and non-medical cannabis use, other substance use and resulting disorders, health-
related functioning, and demographics. These results were then analyzed to estimate the general
association between the categories’ results and veterans while simultaneously providing the
differences based on demographics. Overall, it was shown that around 9% of veterans sampled
used cannabis in 2016, but there were discrepancies between the demographics. This study
provides a basis of information on the number of veterans that use cannabis; although, this
information may not be comprehensive due to this study being based on self-reporting which can
provide biases towards the results. This means that the number of veterans honest about their
self-use of cannabis in 2016 may be lower than the true number of veterans that participate in
using medical or recreational cannabis throughout the nation.
c) Key Insights:
Only 9% of the veterans sampled admitted to using cannabis within 2016, but 48% of these
veterans lived in a legal medical marijuana state; of the 48%, 41% of the veterans living in a
medically legal state report using medical marijuana for medicinal purposes (4). Unfortunately,
this study does not provide further information involving veterans and cannabis; such as, the
prevalence of medical purposes that cannabis is utilized for within this veteran population.
“A recent exception is a study of an online sample of cannabis using Veterans (Loflin,
Earleywine, & Bonn-Miller, 2017). The study found that Veterans using cannabis for medical
reasons reported greater combat exposure, greater PTSD symptoms, greater arousal, more days
of cannabis use in the past month, a greater amount of cannabis consumed per month, and fewer
days of alcohol use in the past month compared with those using recreationally,” (2).
“… Veterans who were 26–34 years and 65 years or older had greater odds of medical use
compared with those ages 18–25 years,” (4).
“The findings from the present study also revealed that, among those with past year cannabis
use, more than twice the proportion of Veterans reported medical use (41%) compared to non-
Veteran adults in the general US population (17%; Lin et al., 2016).” (5).
d) Further Reading:
Benson, T. (2014, Dec. 9). PTSD and Pot: The fight to get veterans some weed. Rolling Stone.
Retrieved from http://www.rollingstone.com/politics/news/ptsd-and-pot-the-fight-to-get-
veterans-some-weed-20141209.
Article 5: Aston, E. R., Bassett, S. S., Borsari, B., Jackson, K. M., & Metrik, J. (2018).
Medicinal Versus Recreational Cannabis Use Among Returning Veterans. Retrieved from
https://web-b-ebscohost-
cb34817a16f2%40pdc-v-sessmgr03
a) Abstract:
Although increasing rates of cannabis use and cannabis use disorder (CUD) are well documented
among veterans, little is known about their use of cannabis specifically for medicinal purposes.
The present study characterizes such use and compares veterans reporting cannabis use for
medicinal (n=66) versus recreational (n=77) purposes on (a) sociodemographic factors, (b)
psychiatric disorders (posttraumatic stress disorder [PTSD], major depressive disorder [MDD],
and CUD), (c) other substance use, (d) reasons for cannabis use and cannabis-related problems,
and (e) physical and mental health. Participants were veterans deployed post 9/11/2001
recruited from a Veterans Health Administration (VHA) facility (N=143; mean [SD] age=30.0
[6.6]; mean [SD] deployments=1.7 [1.1]) who reported past-year cannabis use. The most
frequently endorsed conditions for medicinal cannabis (MC) use were anxiety/stress, PTSD,
pain, depression, and insomnia. In logistic regression analyses adjusted for frequency of cannabis
use, MC users were significantly more likely (odds ratio [OR] = 3.16) to meet criteria for PTSD
than were recreational cannabis (RC) users. Relative to RC users, MC users reported
significantly greater motivation for using cannabis to cope with sleep disturbance, as well as
significantly poorer sleep quality and worse physical health. Veterans who use cannabis for
medicinal purposes differ significantly in sleep, physical, and mental health functioning than do
veterans who use cannabis for recreational purposes. PTSD and sleep problems may be
especially relevant issues to address in screening and providing clinical care to returning veterans
who are using cannabis for medicinal purposes.

b) Relation:
Throughout this article it discussed the differences between medical marijuana use and
recreational marijuana use regarding veterans. Every person participating in the study completed
various questionnaires designed to get further understanding on their: demographics, psychiatric
diagnoses, cannabis use and other substance use-related variables, and psychical and mental
health characteristics. Many of the veterans within the study reported using marijuana for
medical purposes even though only about 25% of them have their medical marijuana card.
Nearly 97% of the veterans that use marijuana and have a condition found it to help moderately
or better. Of the 66 veterans sampled, there were 22 that had a current diagnosis of PTSD and 33
that had a lifetime diagnosis of PTSD. Overall, the study seemed to indicate that more than half
of the veterans that used marijuana for medical purposes seemed to use it for PTSD or chronic
pain, possibly both. This scholarly article will provide me with very recent data regarding
veterans’ medical marijuana use, the conditions it was used for, and the effects experienced by
the participants.
c) Key Insights:
Out of 66 people within this study 43 have sought out medical marijuana for PTSD and 41 have
sought out medical marijuana for chronic pain (6). Throughout the results it was noted that
veterans used medical marijuana daily; due to the information previously stated it is most likely
to cope with symptoms of PTSD and chronic pain.
“PTSD is now recognized as a qualifying condition by the majority of states permitting legal
access to medicinal cannabis,” (2).

“… PTSD (…65%) than chronic pain (62%),” (9).
“although 62% of MC users reported having a medical condition that would qualify them for a
medical marijuana registration card in their state, only 24% reported having obtained one. One
possible explanation for this discrepancy that we can posit from our data is that nearly 26% of
MC users reported that they refrained from discussing medical cannabis with their doctor out of
concern that doing so may get them into trouble and/or negatively affect their benefits and
services at the U.S. Department of Veterans Affairs (VA),” (9).
d) Further Reading:
Cohen, B. E., Gima, K., Bertenthal, D., Kim, S., Marmar, C. R., & Seal, K. H. (2010). Mental
health diagnoses and utilization of VA non-mental health medical services among returning Iraq
and Afghanistan veterans. Journal of General Internal Medicine, 25, 18-24.
http://dx.doi.org/10.1007/s11606-009-1117-3.
Article 6: Bonar, E. E., Chermack, S. T., Davis, A. K., Ilgen, M. A., Perron, B. E., & Walton, M.
A. (2016). Factors associated with having a medical marijuana card among Veterans with
recent substance use in VA outpatient treatment. Retrieved from https://web-b-ebscohost-
a) Abstract:
“Psychiatric symptoms, somatic problems, and co-occurring substance use have been associated
with medical marijuana consumption among civilian patients with substance use disorders. It is
possible that these factors may impact Veterans' ability to engage in or adhere to mental health
and substance use disorder treatment. Therefore, we examined whether psychiatric functioning,
substance use, and somatic problems were associated with medical marijuana use among
Veterans receiving substance use disorder and/or mental health treatment. Participants (n = 841)
completed screening measures for a randomized controlled trial and 67 (8%) reported that they
had a current medical marijuana card. Most of these participants (78%) reported using marijuana
to treat severe/chronic pain. Significant bivariate differences revealed that, compared to
participants without a medical marijuana card, those with a card were more likely to be in a
middle-income bracket, unemployed, and they had a significantly higher number of recent days
of marijuana use, synthetic marijuana use, and using sedatives prescribed to them. Additionally,
a significantly higher proportion of participants with a medical marijuana card scored above the
clinical cutoff for posttraumatic stress disorder (PTSD) symptoms, had significantly higher
severity of sleep-related problems, and reported a higher level of pain. These findings highlight
the co-occurrence of substance use, PTSD symptoms, sleep-related problems, and chronic pain
among Veterans who use medical marijuana. Future research should investigate the inter-
relationships among medical marijuana use and other clinical issues (e.g., PTSD symptoms,
sleep, pain) over time, and potential implications of medical marijuana use on treatment
engagement and response.”
b) Relation:
This study’s purpose was meant to evaluate the connection between veterans’ use of medical
marijuana and somatic problems, psychiatric functioning, and substance use. Although there are
inconsistencies between research done regarding PTSD and medical marijuana, it is currently an
approved treatment method for the condition in certain legal states. Throughout this study the
researchers determined to analyze the measures of: medical marijuana use, posttraumatic stress
disorder, patient health, generalized anxiety disorder, insomnia, substance use, military service
history, pain intensity, and patient demographics. Of the 841 veteran participants within the
study, 78% used medical marijuana for severe, chronic pain while 6% responded using medical
marijuana for PTSD (3). There are possible co-occurring symptoms with veterans using medical
marijuana; if these symptoms are not simultaneously addressed, then medical marijuana may not
be as effective. Fortunately, this study provides a sample responding to which conditions that
they, as veteran medical marijuana patients, are using their prescription for. This provides
information regarding the specific sub-populations I will be discussing within my research paper,
veterans with either chronic pain or PTSD.
c) Key Insights:
Since PTSD is now a recognized condition to treat with medical marijuana in certain legal states,
the factors associated with PTSD patients may differ from chronic pain patients. This study used
a multitude of analytical tools to determine the differences between various data that was
collected with their research. Due to the data being self-reported it may have been biased due to
retrospective recall and social desirability.
“A significantly larger proportion of participants with a medical marijuana card were above the
clinical cutoff for significant PTSD symptoms (58% vs. 39%), χ2 (1, 829) = 9.04, p = 0.003, φ =
0.10,” (3).
“… the combination of marijuana and sedative use is perhaps not surprising among individuals
who choose medical marijuana treatment, given the likelihood that these individuals might be
prescribed (or recommended) several medications to manage a variety of co-occurring somatic
and psychiatric problems,” (4).

d) Further Reading:
Boden, M. T., Babson, K. A., Vujanovic, A. A., Short, N. A., & Bonn-Miller, M. O. (2013).
Post-traumatic stress disorder and cannabis use characteristics among military veterans
with cannabis dependence. The American Journal on Addictions, 22, 277–284.

Section III—Conclusion
Due to the intense, high-stress situations that veterans have endured within the armed forces
many return to the states with debilitating mental or physical conditions that can lessen their
quality of life. Many patients start with taking prescription medication in order to improve their
symptoms; however, these medications can provide various negative effects. Therefore, some
search for alternative treatment methods to assist with their conditions, one of these treatments
being medical marijuana. Medical marijuana seems to be the last resort for many patients,
including veterans, which is most likely due to the legal issues surrounding the plant itself, the
effect it could have on their healthcare, and issues regarding employment. Although some
believe that this treatment is simple and only requires one viewpoint in order to understand;
however, medical marijuana is a complex treatment that requires interdisciplinarity. Out of the
six articles, I believe that four of them provide the best information for my research paper
regarding veterans’ alternative treatment method of using medical marijuana for PTSD and
chronic pain. These four articles include: Blurred Boundaries: The Therapeutics and Politics of
Medical Marijuana, Recent cannabis use among Veterans in the United States: Results from a
national sample, Medicinal Versus Recreational Cannabis Use Among Returning Veterans, and
Factors associated with having a medical marijuana card among Veterans with recent substance
use in VA outpatient treatment. Each of these articles provide information regarding medical
marijuana and the effects associated with its use; however, three of the four discuss veterans
specifically and provide information connecting medical marijuana and treatment for PTSD or
chronic pain.
References Page
References
Aston, E. R., Bassett, S. S., Borsari, B., Jackson, K. M., & Metrik, J. (2018). Medicinal Versus
Recreational Cannabis Use Among Returning Veterans. Retrieved from https://web-b-ebscohost-
Bellnier, T., Brown, G. W., & Ortega, T. R. (2018). Preliminary evaluation of the efficacy,
safety, and costs associated with the treatment of chronic pain with medical cannabis. Retrieved
from https://web-b-ebscohost-
Bohnert, K. M., Davis, A. K., Ilgen, M. A., & Lin, L.A. (2018). Recent cannabis use among
Veterans in the United States: Results from a national sample. Retrieved from https://web-b-
ebscohost-com.ezproxy.net.ucf.edu/ehost/search/advanced?vid=28&sid=2e088d1b-0934-44a0-
890d-cb34817a16f2%40pdc-v-sessmgr03.
Bonar, E. E., Chermack, S. T., Davis, A. K., Ilgen, M. A., Perron, B. E., & Walton, M. A.
(2016). Factors associated with having a medical marijuana card among Veterans with recent
substance use in VA outpatient treatment. Retrieved from https://web-b-ebscohost-
Bostwick, J. M. (2012). Blurred Boundaries: The Therapeutics and Politics of Medical
Marijuana, Retrieved from https://web-b-ebscohost-

Davidson, E., Furmanov, K., Ginosar, Y., Haroutounian, S., Meidan, R., Ratz, Y., & Saifi, F.
(2016). The Effect of medicinal cannabis on pain and quality of life outcomes in chronic pain: a
prospective open label study. The Clinical Journal of Pain Publish Ahead of Print. Retrieved
from https://web-b-ebscohost-

Hybrid Lit Annotated Bib

Hochgeladen von

Dokumentinformationen

Originaltitel

Copyright

Verfügbare Formate

Dieses Dokument teilen

Dokument teilen oder einbetten

Freigabeoptionen

Stufen Sie dieses Dokument als nützlich ein?

Sind diese Inhalte unangemessen?

Copyright:

Verfügbare Formate

Hybrid Lit Annotated Bib

Hochgeladen von

Copyright:

Verfügbare Formate

Medical Marijuana and Veterans: Truly a treatment for chronic pain and PTSD?

Hybrid Literature and Annotated Bibliography Review

IDS 4934- Interdisciplinary Studies Capstone Spring 2019

Devon Caldwell Bazata

College of Undergraduate Studies

University of Central Florida

Section I—Introduction and Problem Statement

patients in obtaining their prescription. Economics allows for a concentrated understanding of

U. S. Department of Veterans Affairs. (n.d.). How Common is PTSD in Veterans? Retrieved

Section II—Article Review and Annotated Bibliographies

Article 1: Bostwick, J. M. (2012). Blurred Boundaries: The Therapeutics and Politics of

Medical Marijuana, Retrieved from https://web-b-ebscohost-

promising pharmaceutical applications, even as draconian federal restrictions that hamstring

important facts within each section towards my research paper.

reclassification of marijuana from a Schedule I controlled substance to a Schedule II controlled

Association, and the American College of Physicians (12).

nervous system, immune system, gastrointestinal tract, reproductive system, cardiovascular

system, and endocrine network,” (7).

mans has never been reported,” (8).

of each preparation and minimize the incidence of undesirable reactions,” (9).

acceptable indications, appropriate prescriber-patient relationships, or legitimate means of

acquiring botanical cannabis,” (12).

Retrieved from https://web-b-ebscohost-

treatment resistant chronic pain.

problems, and change in opioid consumption.

emotional disability scores. Opioid consumption at follow-up decreased by 44% (P<0.001).

Serious adverse effects led to treatment discontinuation in two subjects.

non-controlled nature should be considered when extrapolating the results.”

8.0%, and deteriorated in 26.1% of subjects,” (9).

87.5) to 75.0 (95% CI, 70.8-79.2), P < 0.001,” (9).

the American Medical Association, 313: 2456-73.

Retrieved from https://web-b-ebscohost-

“Introduction: Medical cannabis (MC) is commonly claimed to be an effective treatment for

supporting this claim has never been greater.

months post-therapy. The secondary outcomes included comparisons of monthly analgesic

side effect incidence.

role of MC in the treatment of chronic pain.”

analgesic prescription costs.

“annoying” after 3 months therapy,” (Results; lines 10-12).

psychiatric problems: a clinical review. JAMA. 313 (24):2474-83. DOI:

medical and non-medical cannabis use among this important US sub-population.

Veterans using non-medically.

using medical or recreational cannabis throughout the nation.

“A recent exception is a study of an online sample of cannabis using Veterans (Loflin,

compared with those ages 18–25 years,” (4).

Retrieved from http://www.rollingstone.com/politics/news/ptsd-and-pot-the-fight-to-get-

who are using cannabis for medicinal purposes.

various questionnaires designed to get further understanding on their: demographics, psychiatric

to cope with symptoms of PTSD and chronic pain.

access to medicinal cannabis,” (2).

“… PTSD (…65%) than chronic pain (62%),” (9).

services at the U.S. Department of Veterans Affairs (VA),” (9).

and Afghanistan veterans. Journal of General Internal Medicine, 25, 18-24.

recent substance use in VA outpatient treatment. Retrieved from https://web-b-ebscohost-

to treat severe/chronic pain. Significant bivariate differences revealed that, compared to

engagement and response.”

veterans with either chronic pain or PTSD.

retrospective recall and social desirability.

prescribed (or recommended) several medications to manage a variety of co-occurring somatic

and psychiatric problems,” (4).

with cannabis dependence. The American Journal on Addictions, 22, 277–284.

Recreational Cannabis Use Among Returning Veterans. Retrieved from https://web-b-ebscohost-

substance use in VA outpatient treatment. Retrieved from https://web-b-ebscohost-